Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department.

Aiham Qdaisat,Sai-Ching J Yeung,Mona Kamal,Ziyi Li,Pavani Samudrala,Cristhiam H Rojas Hernandez,Adriana H Wechsler

doi:10.3390/jcm11030643

Aiham Qdaisat, Sai-Ching J Yeung + Show 5 more

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https://doi.org/10.3390/jcm11030643

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Abstract

Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. To evaluate the characteristics and clinical outcomes of cancer patients with ICH, we identified all patients with ICH who visited The University of Texas MD Anderson Cancer Center emergency department between 1 September 2006 and 16 February 2016. Clinical and radiologic data were collected and compared. Logistic regression analyses were used to determine the association between clinical variables and various outcomes. During the period studied, 704 confirmed acute ICH cases were identified. In-hospital, 7-day, and 30-day mortality rates were 15.1, 11.4, and 25.6%, respectively. Hypertension was most predictive of intensive care unit admission (OR = 1.52, 95% CI = 1.09–2.12, p = 0.013). Low platelet count was associated with both in-hospital mortality (OR = 0.96, 95% CI = 0.94–0.99, p = 0.008) and 30-day mortality (OR = 0.98, 95% CI = 0.96–1.00, p = 0.016). Radiologic findings, especially herniation and hydrocephalus, were strong predictors of short-term mortality. Among known risk factors of ICH, those most helpful in predicting cancer patient outcomes were hypertension, low platelet count, and the presence of hydrocephalus or herniation. Understanding how the clinical presentation, risk factors, and imaging findings correlate with patient morbidity and mortality is helpful in guiding the diagnostic evaluation and aggressiveness of care for ICH in cancer patients.

Highlights

Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment
The higher mortality rate in the hospital study may be a result of the exclusion of patients with brain tumors since we found that patients with intratumor bleeding often had a shorter hospital stay and lower rates of intensive care unit (ICU) admission, in-hospital mortality, and 7-day mortality
The increased frequency of ICU admissions undoubtedly reflects greater disease severity. We assumed this higher morbidity and mortality may largely be due to underlying thrombocytopenia; in our multivariable analysis of in-hospital mortality, every incremental drop in platelet count of 10 K/uL increased the mortality risk by 4%, and we know that patients with hematologic malignancies often have platelet counts below 50 K/uL, with some cases reaching below 20 K/uL

Summary

Introduction

Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. Intracerebral hemorrhage represents only 10–20% of strokes but is more deadly, with a reported case fatality ratio of 24–37% at 7 days and 40–59% at 30 days [1–6]. Among cancer patients, both the incidence of ICH and ICHassociated mortality rates are assumed to be increased, heightening the need for a clear understanding of the characteristics of cancer patients with ICH and how these characteristics affect outcomes. Some studies considered only liquid tumors or primary CNS tumors, increasing susceptibility to bias effects [7–10]. Other studies focus on one risk factor, such as anticoagulation therapy, without consideration for its interplay with others [9,11]

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